To explore the feasibility of uniportal VATS complex sleeve lung resection and summarize the surgical techniques and clinical outcomes.

From 2016 to 2019, a total of 167 cases of uniportal thoracoscopic sleeve lung resection were perfomed by one surgical team in Shanghai Pulmonary Hospital. Among them, there are a total of 141 cases of the upper or lower lobe sleeve resections, already analyzed in previous articles.This article aims to analyze the remaining 26 technique-demanding cases. We categorize these operations as "complex sleeve lung resection" . Inclusion criteria are as follows, sleeve lung resection of more than one lobe (bilobar sleeve resection or lobe + segment sleeve resection), sleeve lung resection involving the carina, sleeve segmental resection, right middle sleeve lobectomy. Exclusion criteria includes sleeve lobectomy through thoracotomy, wedge bronchoplasty, upper or lower sleeve lobectomy. The recruited cases are 7 right upper-middle or middle-lower sleeve bilobectomy, 6 left lower lobe + lingular segment sleeve resection, 6 sleeve carinal resection, 4 sleeve segmentectomy, 3 right middle sleeve lobectomy.

There were 15 cases of lung squamous cell carcinoma, 3 cases of lung adenocarcinoma, 4 cases of hamartoma, 1 case of adenoid cystic carcinoma, 1 case of carcinoid tumor, 1 case of malignant lymphoma, and 1 case of extranodal sinus histiocytosis. The average blood loss during the operation was (169 ± 205.94) ml, 50-1 000 ml. The average operation time was (190.3±72.6) min, with interquartile range 150-232.5 min. The average lymph node stations removed were (5.86±0.99), including station7 in all cases. The number of lymph nodes was 6-29, with an average of (14.04 ± 5.41). On operation day, the drainage volume was (265.41 ± 173.98 )ml. The total hospital stay was (10.38 ± 4.87) d, and postoperative hospital stay was (4.96 ± 1.90) d. Sixteen patients with malignant tumors received postoperative chemotherapy (16/19). One case was lost to long-term follow-up. Anastomotic complications occurred in 1cases. Tumor recurrence occurred in 2 case. Bronchoesophageal fistula occurred in 1 patient after radiochemotherapy. One case suffered postoperative chylothorax recovered after reoperation. The postoperative follow-up time was( 15.6 ± 10.7 )months. No perioperative death occurred. Until now, one patient died of distal metastasis 1 year after operation, and other patients still survive.

Uniportal VATS sleeve complex lung resection could be completed with an improvement of minimally invasive surgical techniques, and be beneficial for certain selective patients.